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Chapter 11 Cognitive Disorders and Life-Span Issues Symptoms of Dementia Memory impairment Aphasia (language disturbance) Aprixia (inability to carry out motor activities despite intact motor function) Agnosia (failure to recognize or identify objects despite intact sensory functioning) Disturbance in executive functioning Changes in emotional and personality functioning Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 2 DSM-IV-TR Diagnostic Criteria for Dementia Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 3 DSM-5 Considerations of Dementia Various forms of dementia are likely to be subsumed under one overarching category of major neurocognitive disorder. This disorder would be characterized by evidence of significant cognitive decline from a previous level of performance that is sufficient to interfere with independence. A diagnosis of minor neurocognitive disorder would apply to individuals with less severe cognitive decline, who might be in the early stages of what will eventually develop into a major neurocognitive disorder. Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 4 Types of Dementia Alzheimer’s disease Vascular disease (blockage of blood to the brain, commonly referred to as a stroke) Head injury Progressive diseases (e.g., Parkinson’s disease and HIV disease) Chronic drug abuse Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 5 Dementia of the Alzheimer’s Type Usually begins after the age of 65, but there is an early-onset type of Alzheimer’s disease Typically begins with mild memory loss As the disease progresses, the memory loss and disorientation become profound About two-thirds show psychiatric symptoms, including agitation, irritability, apathy, and dysphoria As the disease worsens, people may become violent and experience hallucinations and delusions On average, people die within 8 to 10 years Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 6 BRAIN ABNORMALITIES IN ALZHEIMER’S DISEASE Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 7 Brain Map Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 8 Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 9 Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 10 Vascular Dementia Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 11 Dementia Associated with Other Medical Conditions Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 12 Treatments for Dementia Medications Cholinesterase inhibitors (e.g., Aricept), which help prevent the breakdown of the neurotransmitter acetylcholine Other drugs regulate the activity of glutamate (e.g., Namenda) In some cases, drugs do not work for all patients and have only temporary effects Behavior therapies Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 13 Prevention of Dementia Aerobic exercise and mental activity may have some protective value Reducing the risk factors for stroke, for example, avoiding smoking, obesity, and hypertension, may reduce the risk for vascular dementia Nun study: Demonstrated a link between intellectual activity beginning early in life and reduced risk of Alzheimer’s disease Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 14 Delirium Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 15 Causes of Delirum Dementia Many medical disorders, including stroke, congestive heart failure, an infectious disease, a high fever, or HIV infection Intoxication with illicit drugs and withdrawal from these drugs or prescription medications Fluid and electrolyte imbalances Toxic substances Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 16 Amnesia Unlike dementia and delirium, in amnesic disorders only memory is affected Anterograde amnesia—impaired in the ability to learn new information Retrograde amnesia—impaired in the ability to recall previously learned information Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 17 Mental Disorders in Later Life Anxiety Disorders Depression Substance Use Disorders Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 18 Integrated Biopsychosocial Model Chapter 11 Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. 19